Advancing the use of theory in occupational therapy: a collaborative process.

BACKGROUND: Theory is important to the growth and evolution of occupational therapy. However, use of theory remains challenging for many therapists. PURPOSE: The aim was to develop a process that occupational therapists could apply to advance theory in practice. METHOD: Based on a review of the literature and using a qualitative instrumental case study design, 18 student occupational therapists and eight fieldwork educators completed online modules on the theory advancement concepts generated from the literature, wrote journals, and/or participated in online discussions during fieldwork. Following fieldwork, educators were interviewed and students participated in focus groups exploring their experiences. Directed content analysis was used to analyze the data. FINDINGS: Based on the data collected, we developed the Theory Advancement Process (TAP). The TAP is composed of four primary contexts, a climate of collaborative relationships with four key elements, and four essential processes. IMPLICATIONS: The TAP presents a collaborative process for students, faculty, and therapists to work together to advance the use of theory in practice.

Stroke Survivors and their Physiotherapists' Perceptions of Recovery: A Multiple Methods Approach.

Purpose: This multiple-methods study examined perceptions of recovery among stroke survivors and their physiotherapists at discharge from an in-patient rehabilitation program. Method: The Functional Independence Measure (FIM) and Chedoke McMaster Stroke Assessment Activity Inventory scores were collected from chart review and the following outcome measures were completed by interview: Stroke Impact Scale (SIS) global recovery, Hospital Anxiety Depression Scale, and Montreal Cognitive Assessment. Physiotherapists also completed the SIS global recovery for each participant. Spearman and Pearson correlations between SIS recovery and observed measures were completed. The stroke survivors had a short interview about their perception of recovery and what recovery meant to them, and their physiotherapists answered two written questions about each participant's recovery. Responses were coded and categorized based on the International Classification of Functioning. Results: A total of 31 stroke survivors with a mean age of 66.6 years (SD 10.7) and six physiotherapists participated. Nineteen stroke survivors were interviewed. The stroke survivors' SIS recovery scores correlated with FIM-motor change (rs = 0.36 p = 0.04) and the SIS-recovery scores reported by the physiotherapists (r = 0.51; p < 0.01). In relation to the factors related to recovery, the physiotherapists' focus was therapeutic mainly considering motor recovery while the stroke survivors' responses were broad, including being able to achieve recovery goals and nutrition. However, both perceived recovery to include functional activities. Conclusions: SIS global recovery question helps to measure the overall perceived percentage of recovery. However, the complete picture of recovery is only possible with the stroke survivors' and physiotherapists' perceptions of recovery and what recovery means to them.

Objectif: ce sondage à méthodes multiples a porté sur les perceptions du rétablissement chez les survivants d'un accident vasculaire cérébral (AVC) et de leur physiothérapeute lors du congé d'un programme de réadaptation pour personnes hospitalisées. Méthodologie: les chercheurs ont mesuré les scores de la mesure d'indépendance fonctionnelle (MIF) et de l'inventaire des activités de l'évaluation Chedoke McMaster d'après l'analyse des dossiers et ont obtenu les mesures de résultats suivantes au moyen d'entrevues: rétablissement global selon l'échelle d'impact de l'AVC (SIS), échelle hospitalière de mesure de l'anxiété et de la dépression et évaluation cognitive de Montréal. Les physiothérapeutes ont également évalué le rétablissement global selon la SIS de chaque participant. Ils ont effectué les corrélations de Spearman et de Pearson entre le rétablissement selon la SIS et les mesures observées. Les survivants d'un AVC ont participé à une courte entrevue sur leur perception du rétablissement et sur la signification qu'ils donnent au rétablissement, et leurs physiothérapeutes ont répondu à deux questions écrites sur le rétablissement de chaque participant. Les réponses ont été codées et classées d'après la Classification internationale du fonctionnement. Résultats: au total, 31 survivants d'un AVC ayant un âge moyen de 66,6 ans (ÉT 10,7) et six physiothérapeutes ont participé. Dix-neuf survivants d'un AVC ont été interviewés. Leur score de rétablissement selon la SIS était corrélé avec les changements moteurs selon la MIF (sr = 0,36 p = 0,04) et les scores de rétablissement selon la SIS signalés par les physiothérapeutes (r = 0,51; p < 0,01). Pour ce qui est des facteurs liés au rétablissement, les physiothérapeutes se concentraient sur les aspects thérapeutiques et tenaient surtout compte du rétablissement moteur, mais les réponses des survivants d'un AVC étaient vastes, puisqu'elles incluaient la capacité de réaliser les objectifs du rétablissement et l'alimentation. Cependant, les deux groupes trouvaient que le rétablissement incluait les activités fonctionnelles. Conclusions: les questions sur le rétablissement global selon la SIS contribuent à mesurer le pourcentage de perception globale du rétablissement. Cependant, il n'est possible d'obtenir un tableau complet du rétablissement que si l'on connaît les perceptions du rétablissement selon les survivants d'un AVC et les physiothérapeutes et la signification qu'ils donnent au rétablissement.

Occupational therapy services in primary care: a scoping review.

AIM: To examine and describe the current evidence about occupational therapy services in primary care. BACKGROUND: Interprofessional primary care teams have been introduced to support the changing demographics and provide more comprehensive and coordinated care. Occupational therapists have the opportunity to play an important role in this expanding area of practice. To do so, occupational therapists must develop roles built on evidence and a clear understanding of the care delivery context. METHODS: A scoping review was conducted based on the scientific and grey literature. Studies that described or examined the occupational therapy role with clients (individuals, groups, communities, populations) of all ages, conditions or occupational issues in a primary care context and that presented or referred to an occupational therapist working in a primary care setting were included. Studies were excluded if they were not in English or French. The Canadian Model of Occupational Performance and Engagement was used to chart the data. FINDINGS: 129 articles were identified, with 62 non-research and 67 research-focussed articles. A total of 268 assessments and 868 interventions were identified. The top interventions offered by occupational therapists were referring to/advocating for/coordinating/linking to and navigating community services (n = 36 articles), chronic disease management (n = 34 articles)/self-management education (n = 28 articles), health promotion (n = 30 articles) and falls prevention (n = 27 articles). The predominant focus in the literature is on adult and older adult populations.

Profiling the Research Activities of Canadian Occupational Therapy and Occupational Science Faculty Members.

Background. There is a lack of knowledge on the scope and nature of the research by faculty members in occupational science (OS) and/or occupational therapy (OT) programs in Canada. Purpose. To describe the research activities of faculty members in these programs and directions. Method. A cross-sectional survey was distributed to 173 faculty members across all 14 Canadian OT that addressed: 1) research topics and methods, 2) populations, and 3) funding. Findings. Based on respondents (N = 121), research is focused on a range of topics and populations with most conducting qualitative research. Many conduct research examining the effectiveness of interventions, with few respondents focused on OS research. Federal and provincial grants agencies were the largest source of funding. Implications. Research topics studied were not always proportional to practice although emerging areas were being investigated that can expand the evidence base and scope of practice. Despite limited occupation-specific funding options, respondents were accessing funding from varied sources. Collaborations among faculty members, clinicians, and individuals with lived experience can create priorities for future OS and/or OT research in Canada.

Interprofessional Collaborative Relationship-Building Model in Action in Primary Care: A Secondary Analysis.

Introduction: Team-based care has been integrated into primary care (PC) across Canada because it improves patient safety, effectiveness, efficiency, person-centredness, and equity. However, this integration in and of itself may not lead to improved patient care without effective interpersonal relationships amongst team members. Currently, teams have few tools to guide the development of collaborative relationships. The Interprofessional Collaborative Relationship-building Model (ICRB) was developed to be a tool for understanding the stages of development of the interprofessional team's relationship-building. Purpose: This qualitative secondary data analysis illuminates a PC team's experiences of their developing interprofessional relationships with occupational therapists and physical therapists who joined the PC team. Method: Eleven team member interviews of one primary care team from a family medicine teaching clinic affiliated with a training university and the health region in central Canada were analyzed using secondary data analysis. The team included family physicians (n = 4), nurses (n = 2), a social worker (n = 1), a mental health counselor (n = 1), occupational therapists (n = 2), and a physical therapist (n = 1). We used the ICRB for directed content analysis using the phased approach that includes the three main steps of data preparation, data organization and data presentation. Results: This team experienced the ICRB stages of Looking For Help, Fitting-In, and Growing Reciprocity thereby learning about one another to better understand what OT and PT may bring to the PC setting. However, contrary to the ICRB, co-location, was the context within which the collaborative relationship-building took place rather than a distinct developmental stage. Although team members did experience some level of Growing Reciprocity, this developing team had not yet established collaborative leadership processes. As the ICRB originally posited, communication and patient focus facilitated all stages of the relationship-building process and helped the team develop shared values and role clarity that establish how different team members contribute to improving quality care. Conclusions: The context of co-location with a patient focus and open communication facilitated the team's development with the occupational therapists and physical therapist. Collaborative leadership is a worthy goal for future research and clinical focus as it has implications for improving overall patient quality care and team member work satisfaction.

Exploring the delivery of community rehabilitation services for older people in an urban Canadian setting: Perspectives of service providers, managers and health system administrators.

As the global population of older people increases, policies aimed at improving health care delivery for older people often include supports for ageing in place. Living in the community not only reduces institutionalisation but also improves quality of life and reduces health care costs. For older people, community rehabilitation offers the opportunity to preserve and maximise function while maintaining the ability to live in the community. However, limited research examines the delivery, coordination and integration of community rehabilitation services in health systems. Our case study explored the perspectives of service providers, managers and health system administrators on the strengths, limitations and gaps in community rehabilitation for older people in one Canadian urban health region. Using interpretive description and thematic analysis, we analysed interview data from: 16 service providers, eight managers and five health system administrators. Three themes were identified: (a) Limited Access to Programs and Services; (b) Need to Emphasise Promoting, Maintaining and Restoring Function; and (c) Lack of Flow Across the System. Participants highlighted that restrictive eligibility criteria limited access to services. Services were organised around health conditions that did not address the needs of older people. Long waitlists meant that services were delayed. Transportation costs limited participation of individuals from lower socioeconomic status (SES). Age restrictions did not reflect differences in the ageing process and the health inequities individuals from lower SES groups experienced. There was a lack of emphasis in community rehabilitation programs on maintaining or restoring function in older people, which is the primary focus of rehabilitation. Furthermore, key stakeholders stressed the need for strengthening the integration of service delivery across the continuum of care. The findings underscore the need to develop a conceptual framework for community rehabilitation to promote greater system integration, access and availability of services and to optimise functional outcomes for older people.

Experiences of stroke survivors and measurement of post stroke participation and activity across seasons-A mixed methods approach.

Participation and activity post stroke can be limited due to adverse weather conditions. This study aimed to: Quantify and compare summer and winter participation and activity, and explore how community dwelling people with stroke describe their feelings about their level of participation and activity by season. This embedded mixed-methods observational study took place in a city with weather extremes. Community dwelling individuals at least one year post-stroke, able to walk ≥50 metres +/- a walking aide were included. Evaluations and interviews occurred at participants' homes in two seasons: Reintegration to Normal living Index (RNL), Activities-specific Balance Confidence (ABC) and descriptive outcomes. Participants wore activity monitors for one week each season. Analysis included descriptive statistics, non-parametric tests and an inductive approach to content analysis. Thirteen individuals participated in quantitative evaluation with eight interviewed. Mean age 61.5 years, 62% female and mean 6.2 years post-stroke. No differences between winter-summer values of RNL, ABC, or activity monitor outcomes. However, participants felt they could do more and were more independent in summer. The winter conditions such as ice, snow, cold and wind restricted participation and limited activities. Nonetheless, many participants were active and participated despite the winter challenges by finding other ways to be active, and relying on social supports and personal motivation. The qualitative findings explained unexpected quantitative results. Participants described many challenges with winter weather, but also ways they had discovered to participate and be active despite these challenges. Changes to future studies into seasonal differences are suggested.

Re-examining concepts of occupation and occupation-based models: occupational therapy and community development.

BACKGROUND: A growing body of literature supports the role of occupational therapists in community development. Using a community development approach, occupational therapists respond to community-identified occupational needs. They work to build local resources and capacities and self-sustaining programs that foster change within the community and potentially beyond. PURPOSE: The purpose of this paper is to highlight some key issues related to occupational therapy practice in community development. KEY ISSUES: The definitions and classifications of occupation focus primarily on the individual and fail to elaborate on the shared occupations of a community. As well, occupation-based models of practice are not easily applied to occupational therapy practice in community development. IMPLICATIONS: In order for occupational therapy to articulate its role in community development, greater heed needs to be given to the definition and categorization of occupation, occupation-based models of practice, and their application to communities.

An occupational therapy community development practice process.

BACKGROUND.: Little research has focused on the application of the Canadian Practice Process Framework (CPPF) to occupational therapists' work in community development (CD). PURPOSE.: This study sought to describe Canadian occupational therapists' CD practice processes. METHOD.: Using interpretive description, Canadian occupational therapists engaged in CD practice participated in an initial interview and follow-up interview or focus group. Content analysis was used to analyze the data. FINDINGS.: Eight occupational therapists participated in describing a process that focused on five key elements: (1) getting to know the community, (2) getting the ball rolling/planning together, (3) building (upon) occupational opportunities, (4) revisiting the approach, and (5) striving for sustainability. These elements occurred within a practice context and frames of reference related to CD practice. IMPLICATIONS.: Participants outlined a process that was less discrete than the CPPF and highlighted the knowledge and skills needed along with the less tangible attitudes/approaches required to engage with communities.

Creating opportunities for occupational development using the concerns report method.

BACKGROUND: Little research has focused on working with communities to promote and support children's occupational development. AIM/OBJECTIVE: We used the Concerns Report Method (CRM) to identify community supports for parents with young children that could enhance children's occupational development. MATERIAL AND METHOD: We conducted interviews/focus groups with parents (n = 29) and service providers (n = 11). We used content analysis to identify four themes: availability, barriers and facilitators, parent/child transitions, and making connections. The themes were used to create a concerns report survey for parents and service providers. A random sample of parents (n = 319) and convenience sample of service providers (n = 47) in one community area of a Canadian urban center completed the on-line survey. We held a community forum to review the results and identify solutions for action. RESULTS: Parents' highest priorities included childcare, supports in community schools, preschool programs, and supports in one location. Service providers highest priorities included: identification of developmental concerns; parenting education; programs for fathers, programs that offer child care, a doctor, and child care. CONCLUSIONS: Service providers need to engage parents and consider parents' perspectives when planning services to ensure community supports will meet parent identified needs. SIGNIFICANCE: Using community-based participatory research approaches, occupational therapists can contribute to children's occupational development.

International community of practice: learning from experiences of community development and social occupational therapy / Comunidade internacional de práticas: aprendendo com experiências de desenvolvimento comunitário e de terapia ocupacional social

Abstract Introduction Increasingly, occupational therapists and scientists across the globe are calling for a shift away from individualised western medical approaches, to working with communities and collectives, and in the social field. This signals the growing motivation to engage in socially responsive and transformative practices that address political structures and oppressive colonial systems. Objective The purpose of our Community of Practice (CoP) was to explore and describe the epistemologies, vocabularies, and understandings that underpin community development and social occupational therapy within diverse global contexts to advance theoretical perspectives and practices. Method As a CoP of occupational therapy and science scholars situated in four countries (Australia, Brazil, Canada, and South Africa), we met virtually bi-monthly from March 2020 to January 2023. Scholarly work involved critical narrative literature reviews, reflexive presentations, group dialogues, and individual and collective reflections and analyses. Results Individual narratives, four thematic threads, and a selection of vocabularies and epistemologies are presented. The thematic threads were: Connecting and making space for decolonial praxis, Questioning the disconnect between occupational therapy practice and contexts, Examining vocabularies that shape contextually relevant practice, and Engaging a reflexive stance to work towards equity, justice and social rights. Conclusions Generating knowledge that supports ways of knowing, being and doing reflective of multiple languages, sciences, and contexts will strengthen occupational therapy. Maintaining the pluriversal and resisting 'one size fits all' approaches to human occupation/everyday life is essential. This paper offers practitioners a catalyst for initiating decolonising praxis for learning across global contexts.

Resumo Introdução De modo crescente, terapeutas ocupacionais mundialmente estão discutindo mudanças das abordagens médicas ocidentais individualizadas para o trabalho com comunidades, coletivos e no campo social. Isto sinaliza uma motivação crescente para se engajar em práticas socialmente responsivas e transformadoras que abordem estruturas políticas e sistemas coloniais opressores. Objetivo Explorar e descrever epistemologias, vocabulários e entendimentos que sustentam a teoria de desenvolvimento de comunidades e da terapia ocupacional social, em diversos contextos globais para avançar em perspectivas teóricas e práticas. Método A partir de uma Comunidade de Prática de terapeutas ocupacionais e acadêmicos situados em quatro países (Austrália, Brasil, Canadá e África do Sul), nos reunimos virtualmente bimestralmente de março de 2020 até janeiro de 2023. Nosso trabalho envolveu revisões narrativas críticas da literatura, apresentações reflexivas, diálogos em grupo e reflexões e análises individuais e coletivas. Resultados Foram escolhidos quatro fios temáticos e uma seleção de vocabulários e epistemologias: Conectando e abrindo espaço para a práxis decolonial, Questionando a desconexão entre a prática da terapia ocupacional e os contextos, Examinando vocabulários que moldam a prática contextualmente relevante e Engajando uma postura reflexiva para trabalhar em direção à equidade, justiça e direitos sociais. Conclusões A geração de conhecimento reflexivo que sustente formas de saber, ser e fazer requer múltiplas linguagens, ciências e contextos que fortalecem a terapia ocupacional. É essencial manter a pluriversalidade e resistir a abordagens únicas para trabalhar com a ocupação humana/vida cotidiana. Este artigo oferece um catalisador para iniciar uma práxis descolonizadora de aprendizado em contextos globais.

Preparing for community development practice: A Delphi study of Canadian occupational therapists

BACKGROUND: Increasingly, community development is recognized as an important process for occupational therapy practice. However, occupational therapists working in community development report feeling unprepared. PURPOSE: This study aimed to identify the knowledge, skills, and experiences that occupational therapists need for practice in community development. METHOD: Using the Delphi technique, the researchers developed statements from the Round 1 (n = 8) responses of occupational therapists involved in community development practice or scholarship. Rounds 2 (n = 14) and 3 (n = 12) sought to establish consensus among the occupational therapists on the areas of focus. FINDINGS: Participants rated the importance of 64 statements grouped into 11 domains. After three rounds, researchers eliminated six statements by analyzing the median, interquartile range, and percentage of agreement. Participants reached consensus on 58 statements. IMPLICATIONS: Many of the competencies identified were relevant to all areas of practice, while others were specific to community development, suggesting a need for specialized education and training in this area. The results provide information that can be used to enhance the preparation of occupational therapists for practice in community development.

Occupational therapy in primary care: Results from a national survey: L'ergothérapie dans les soins primaires : Résultats d'un sondage national.

BACKGROUND.: To support integration of occupational therapy in primary care and research in this area, it is critical to document examples of occupational therapy in primary care. PURPOSE.: This study describes occupational therapy roles and models of practice used in primary care. METHOD.: An electronic survey was sent to occupational therapists across Canada. Participants were identified using purposive and snowball sampling strategies. Descriptive statistics were used to analyze the data. FINDINGS.: Respondents ( n = 52) were almost exclusively working on interprofessional teams. Intervention was provided most frequently to individual clients, and services were provided both within the home/community and in the clinic. Occupational therapists offered a range of health promotion and prevention services, predominantly to adults and older adults. A number of supports and barriers to the integration of occupational therapy were identified. IMPLICATIONS.: A growing number of occupational therapists are working in primary care providing a broad range of services across the life span.